Pharmacognosy Presentation.

1. Presented By: Arslan(13893) Usman(14254) Daniyal(14681)
Abdullah(14659)
Topic:
Cardiac Deseases And Herbs Use Against Them
Presented to: DR. RABEEA KHAN
RIPHAH INSTITUTE OF PHARMACEUTICAL
SCIENCES
PHARMACOGNOSY

2. CONTENTS
o Hypertension
o Plants Used in Hypertension
a) Rauwolfia Serpentina
b) Veratrum
o Angina & Arrythmias
o Plants used in Angina & Arrythmias:
a)Crataegus hawthorn
b)Convallaria majalis
Congestive Heart Failure
o Plants used in Congestive Heart Failure:
a) Digitalis.
o Atherosclerosis
o Plants used in Atherosclerosis:
a) Allium sativum.
b) Punica granatum.

3. Introduction
Cardiovascular disease (CVD) is a class of diseases that
involve the heart or blood vessels. Cardiovascular
disease includes coronary artery diseases (CAD) such
as angina, heart arrhythmia, hypertension,
peripheral and central vascular
disease and myocardial infarction (heart failure).

4. Hypertension

5. Hypertension is:
High Blood Pressure, a medical condition in which constricted arterial
blood vessels increase the resistance to blood flow, causing an increase
in blood pressure against vessel walls.
• Simply put, as a common disorder in which blood pressure remains
abnormally high.
• Affects ~50 million people in the US
Types of Hypertension
• Types:
– 1. Primary
• Chronic high blood pressure without a source or associated with any other
disease
• Most common form of hypertension
– 2. Secondary
• Elevation of blood pressure associated with another disease such as kidney
disease

6. • The organs and tissue in your body
need oxygen to survive.
• Oxygen is bound to your blood and is
delivered( after an exchange of
carbon dioxide for oxygen in your
lungs) to your body by blood vessels.
• When your heart beats, it creates
pressure that pushes blood through
your arteries and veins, also known as
blood vessels and capillaries.
• Blood pressure is the force of blood
pushing against your blood vessel
walls.
• Your blood pressure must be within a
normal range to properly deliver this
oxygen rich blood to your organs and
tissues in order to survive.

7. • When someone has high blood pressure , this increased force makes the heart
work harder to pump blood to the body.
• The increased force puts a strain on both the heart and the blood vessels.
• If the force of the blood flow is high for some time, eventually the tissue that
makes up the walls of the arteries gets stretched beyond its healthy limit.
• This overstretching of the blood vessels makes them more prone to rupture.
• Damages to the vessels results in the development of Atherosclerosis
( hardening of the arteries).
• Uncontrolled high blood pressure increases your risk of serious health
problems, including heart attack and stroke

8. Causes
• Genetics-some people are prone to hypertension simply based off
of their genetic makeup
• Family History- your risk for high blood pressure/hypertension
increases if it is in your family history
• Environment
– Inactivity
– Stress
– Obesity
– Alcohol
– High Sodium Diet
– Tobacco Use
– Age
– Menopausal Medications

9. Further Complications of High Blood Pressure
• Thickening of the heart muscle
• Increased workload of the heart
• May lead to other conditions such as:
– Heart attack
– Stroke
– Renal (Kidney) Failure
– Loss of vision

10. • Those who have higher sensitivity to salt are at
higher risk of hypertension…
So why salt is bad ?

11. Signs and Symptoms
• Diagnosed through repeat blood pressure readings
• Primary Hypertension does not have symptoms
other than high blood pressure
• Secondary Hypertension
– Most likely caused by Renal Disorders, symptoms
you will see:
• Decreased urine formation
• Increased sodium and water retention

12. Plants Used In Hypertension

13. Rauvolfia serpentina
Common Names:Serpentine wood, chandarbagha and Indian snakeroot.
Botanical Name:Rauvolfia serpentina.
Part used: Dried Root.
Family: Apocynaceae.
Geographical regions:
It is distributed in Central and South America, Africa, India, Sri Lanka, Burma, China and Japan
Chemical Constituents:
Rauvolfia root contains more than 200 alkaloids. The major alkaloids are divided into two groups:
Ajmaline group:
Ajmaline, Ajmalinine and Ajmalicine.
Serpentine group: Serpentine and Serpentinine.
Others include:Reserpine, Rescinnamine and Yohimbine,indobine, and deserpidine.
The roots also contain oleoresins, a sterol, unsaturated alcohols, oleic acid, fumaric acid,
glucose, sucrose, a derivative or oxymethylantheraquinone, a strongly fluorescent substance
and mineral salts

14. Mechanism of Action:
• Reserpine was one of the first drugs used on a large scale to treat systemic
hypertension. It acts by irreversibly blocking the uptake of biogenic amines
(norepinephrine, dopamine, and serotonin) in the storage vesicles of central and
peripheral adrenergic neurons, thus leaving the catecholamines to be destroyed by
the enzyme monoamine oxidase in the cytoplasm.
• The depletion of catecholamines accounts for reserpine's sympatholytic and
antihypertensive actions.
• Reserpine's effects are long lasting, since recovery of sympathetic function
requires synthesis of new storage vesicles, which takes days to weeks.
• Dose:
The daily oral dose of reserpine should be 0.25 mg or less, and as little as 0.05 mg
if given with a diuretic. Using the whole root, the usual adult dose is 50 to 200
mg/d administered once daily or in 2 divided doses

15. • Uses:
• The root extract obtained is considered to be the best medicine for high
blood pressure, mental agitation, insomnia and also used as a sedative.
• Extracts of R.serpentina is also helpful in curing other diseases such as
fever, malaria, eye diseases, pneumonia, asthma, headache, skin disease
and spleen disorder.
• The plant extract has anti-prostate cancer activity.
• Used in the treatment of cholera.
• Used to treat liver pain, stomach pain and to expel intestinal worms.
• Extracts of the roots are valued for the treatment of intestinal disorders,
particularly diarrhoea and dysentery and also as anathematic.

16. Veratrum album
Common Name: white hellebore, European white hellebore or white veratrum.
Botanical Name: Veratrum album.
Part Used: Roots and rhizome.
Family:Melanthiaceae.
Geographical distribution:Canada, Alaska, USA and Asia
Chemical Constituents:
Veratrum contains steroidal alkaloids
Veratralbine 0.03
jervine 0.1%
Barytine.
Protoveratridine 0.005%
Pseudo-jervine 0.1%
Rubijervine 0.005%
Protoveratrine 0.1%.

17. Mechanism of Action:
• Veratrum alkaloids enhance nerve and muscle excitability by increasing sodium ion
conductivity.
• They act on the posterior wall of the left ventricle and the coronary sinus
baroreceptors, causing reflex hypotension and bradycardia via the vagus nerve
(Bezold-Jarisch reflex).
Dose:
• 3 x dilution may be added to water in the proportion of 30 drops of the tincture to
4 fluid ounces of water, the dose of which, in severe cases, is a teaspoonful every
15 minutes.
• For its earlier uses, the dose of the powder is from 1 to 8 grains, gradually and
cautiously increased, commencing with 1 grain, from 20 to 60 minims. Its use
always requires great care.

18. • Medicinal Uses:
• In the treatment of hypertension.
• In the form of decoction or ointment, as an external
application to kill lice, and cure the itch, pruritis, scabies
and some other cutaneous affections.
• It has been used for the cure of gout.
• It used to be employed in cholera infantum, cholera
morbus and asiatic cholera in all of which it also checks
the vomiting

19. ANGINA PECTORIS
By Muhammad Usman Sarwar
14254

20. Angina Pectoris
• is recurring acute chest pain or discomfort resulting from decreased
blood supply to the heart muscle (myocardial ischemia).
• “Increasing Demand of oxygen but the heart can’t supply”
• Generally due to obstruction or spasm of the coronary arteries.
• The chest pain comes either as a form of pressure or discomfort
when blood flow is reduced, your heart does not get as much
oxygen asit needs.
• This lack of oxygen is what causes the pain and discomfort of
angina.
• If you have coronary heart disease, angina is the way your heart
tells you it needs more oxygen

21. Types
Angina is consisted of three types:
• Stable
• Unstable
• Variant (Prinzmetal's Angina)

22. Stable Angina
• Most common type
• when the patient has greater than or equal to 70% stenosis
• Induced by physical activity (increase demand of O2), or emotional
stress.
• And can’t be supplied because of partially occluded coronary artery
caused by atherosclerosis)
• The pain is relieved by rest.

23. Causes of stable angina
• Atherosclerosis of one or more coronary arteries—
arteries supplying blood to the heart muscles.
• Or thickened heart muscle wall, which would require
more oxygen.
– This increase in muscle size can be due to hypertrophic
cardiomyopathy from a genetic cause, or as a result from the heart
having to pump against higher pressures, as is the case in aortic
stenosis, which is a narrowing of the aortic valve, or hypertension.
These larger, thicker heart muscles require more oxygen, and if the
patients can’t meet increasing demands, they feel pain in the form of
angina.

24. p

25. Unstable Angina
Dangerous and requires emergency treatment.
Unstable angina is the rupture of the fibrous cap, leading to the blockage of
the artery by clotted blood.
• Occurs with increasing frequency (progression)
• Patients have pain during exercise or stress as well as
during rest—it never really goes away.
• Can lead to MI.

27. Vasospastic Angina(prinzmetal's Angina)
• Patients may or may not also have atherosclerosis.
• Ischemia, and resulting chest pain is due to coronary
artery vasospasms, meaning the muscles around the
arteries constrict extremely tightly and reduce blood flow
enough cause ischemia.
• Episodes of vasospastic angina can happen anytime.
• The underlying mechanism causing vasospasms isn’t well
understood, but most likely involves vasoconstrictors like
platelet thromboxane A2.

28. • Coronary artery is constricted severely that all layers
of the heart wall being supplied are affected,
therefore it’s referred to as transmural ischemia.

30. Plants used in Angina :

31. Crataegus Hawthorn
Common Name: Hawthorne, Mayblossom, hedgethorn, maybush, mayflower.
Botanical Name: Crataegus oxyacantha & C.monogyna
Part Used: leaves, flowers and fruits
Family:Rosaceae
Geographical distribution:
England and other European countries such as Albania, Bulgaria, Romania,
Hungary, Macedonia and Poland.
Chemical Constituents:
• Hawthorn contains around 1-2% flavonoids,
• Oligomeric proanthocyanidins (1-3%),
• Saponins,
• Phenolic acids (chlorogenic acid, caffeic acid),
• 2-2-Phenylethyl chromone derivatives (in the flowers, leaves and buds)
• Amine (phenethylamine, metoksyfenetylamin, dopamine, acetylcholine and
tyramine) and triterpenes based on ursolic acid and oleanolic acid.
• Anthocyanin is found in the fruit peel and the fruit contains essential oil, pectin,
vitamin C and other substances.

32. Mechanism of Action:
• Hawthorn works by increasing stroke volume, where the amount of blood per heart beat is
increased, and lowering blood pressure and pulse rate.
• The primary mechanism involves cyclic AMP (adenosine monophosphate). When stimulated,
receptors on the outsides of muscle cell membrane enable the synthesis of adenylyl cyclase.
• The presence of cAMP activates the calcium channels in the muscle cell membranes. In heart
muscle cells, calcium influx promotes increased heart contractility.
• When epinephrine and norepinephrine bind to membrane receptors, a chain reaction is initiated;
the increased calcium level results in increased ionotropic capacity and negative chronotropic
actions.
• The mechanism of cardiac action for Crataegus species is due to the inhibition of the 3‘, 5‘-cyclic
adenosine monophosphate phosphodiesterase.
• Crataegus constituents act as natural angiotensin converting enzyme (ACE) inhibitors. ACE is an
important enzyme involved with blood pressure regulation and also sodium and electrolyte balance
in tissues. Inhibiting ACE also serves to lower blood pressure and strengthen heart muscle
function.
• Crataegus inhibits ACE, presumably due to its procyanidin oligomers. When this enzyme is
inhibited, angiotensin I is not converted to angiotensin II. As a result, the production of aldosterone
is reduced. Since aldosterone promotes water and sodium retention,in its absence sodium and
water are more easily excreted.

33. • Medicinal Uses:
• Crataegus has long been used as a heart tonic for both hyper-
and hypotension.
• Crataegus also regulates heart rhythm in patients with heart
failure.
• Crataegus to improve aortic contractility in heart failure.
also be helpful in treating elevated cholesterol levels and
atherosclerosis.
• Dose:160 to 1,800 mg/day standardized extracts in divided
doses over 3 to 24 weeks. 900mg in CCF is also safe

34. Convallaria Majalis
• Common Name:Lily of the valley
Botanical Name: Convallaria majalis
Part Used:Flowers, leaves and root. The fresh leaves
have the most potency.
Family:Asparagaceae.
• Geographical distribution:
Lily of the valley is native to Europe, but is found
abundantly throughout the Eastern United States,
Northern Asia and in England

35. • Chemical Constituents:
Roughly 38 different cardiac glycosides have been found in lily of
the valley, some among others: convallatoxin, convallotoxole,
convallarin, convallamarin, convalloside,
convallotoxoloside saponins, flavonoids, asparagin etc. Only two of
these substances act directly on the heart.
• Convallamarin, the active principle, a white crystalline powder,
readily soluble in water and in alcohol, but only slightly in ether,
which acts upon the heart like Digitalin, and has also diuretic action,
and Convallarin, which is crystalline in prisms, soluble in alcohol,
slightly soluble in water and has a purgative action. There are also
present a trace of volatile oil, tannin, salts, etc.

36. Mechanism of Action:
• Herbalists have considered the roots of the Convallaria plant to be a
treatment for a weak heart, shortness of breath tachycardia and
arrythmia.
• The Convallaria plant transforms convalloside (the basic metabolic
glycoside) into convallatoxin and other cardiac glycosides.
• Convallatoxin affects vasoconstriction and vasodilation, and cardiac
stroke volume, pulse pressure and cAMP activity are all enhanced
by Convallaria.
• It is also a lipoxygenase inhibitor
Dosage:
• Tincture (1:5, 40%), 0.5-1.0 ml.
• Infusion: 1 tsp/cup.
• Dried leaves: 60-200mg TID.
• Short term use best (4-6 weeks).

37. Medicinal Uses:
• It has similar but milder cardiac effects to Digitalis but without the toxic
buildup.
• Exerts a positive inotropic and negative chronotropic action on the heart
and is specific for congestive heart failure with edema.
• It is most indicated in bradycardic and/or arrhythmic forms of heart
failure.
• Mitral stenosis, mitral regurgitation and corpumonale are especially good
indications for its use.
• In aromatherapy, the essential oil of lily of the valley is used to relieve
depression, imbue gentleness, happiness, modesty, a sweet disposition
and sense of security.
• The herb has been used for weak contractions during childbirth as well as
for epileptic seizures, strokes, angina and ensuing paralysis, conjunctivitis
and leprosy.
Toxicity:
Signs of toxicity: nausea, vomiting, violent purging, cardiac arrhythmias,
increased blood pressure, restlessness, trembling, mental confusion,
extreme weakness, depression, collapse of circulation, and death. Monitor
BP and edema. Berries are poisonous.

38. CONGESTIVE HEART FAILURE
By Abdulllah Tariq
14659

39. CONGESTIVE CARDIAC FAILURE
• Definition:
Heart failure in which the heart is unable to maintain
adequate circulation of blood in the tissues of the body
or increase in myocardial oxygen demand and decreased
myocardial oxygen supply.
OR
It is a common clinical disorder that results in
pulmonary vascular. congestion and reduced cardiac
output. CHF patient usually presents with dyspnea and
respiratory failure.

40. PATHOPHYSIOLOGY
Pathology:
• CHF arises as a consequence of an abnormality in
cardiac structure, function, rhythm, or conduction.
• Ventricular dysfunction accounts for the majority of
cases and results mainly from myocardial infarction
(systolic dysfunction), hypertension (diastolic and
systolic dysfunction), or in many cases both.
• Degenerative valve disease, idiopathic
cardiomyopathy, and alcoholic cardiomyopathy are
also major causes of CHF.

41. CHF indicates inability of the heart to maintain
adequate oxygen delivery; it is also a systemic response
attempting to compensate for the inadequacy. The
determinants of cardiac output include heart rate and
stroke volume(the volume of blood pumped from the left
ventricle per beat.). The stroke volume is further
determined by the preload (the volume that enters the
left ventricle),contractility and afterload (the impedance
of the flow from the left ventricle).

42. PATHOPHYSIOLOGY Cont..
There are 2 mechanisms of reduced cardiac
output and heart failure:
• Systolic dysfunction
• Diastolic dysfunction

43. Systolic Dysfunction
• The most common causes of systolic dysfunction
(defined by a left-ventricular ejection fraction of
50%) are ischemic heart disease, idiopathic dilated
cardiomyopathy, hypertension, and valvular heart
disease.

44. Diastolic Dysfunction
• Diastolic dysfunction (defined as dysfunction of left-
ventricular filling with preserved systolic function)
may occur in up to 40–50% of patients with heart
failure and it increases in frequency with each
decade of life.
• Causes: Hypertension, ischemic heart disease,
hypertrophic cardiomyopathy, and restrictive
cardiomyopathy.

45. PATHOPHYSIOLOGY
Physiology:
• Cardiac structural abnormality; ardiovascular
response to poor perfusion with the activation of the
neurohumoral system.
• Activation of the renin-angiotensin system attempts
to increase preload by stimulating retention of salt
and water, increasing vasoconstriction, and
augmenting cardiac contractility. Initially, this
response will suffice, but prolonged activation results
in loss of myocytes and maladaptive changes in the
surviving myocytes.
• The stressed myocardium undergoes remodeling and
dilation in response to the insult.

46. Cont…
• This process also has detrimental effects on the
functioning of the lungs, kidneys, muscles, blood
vessels, and probably other organs.
• Remodeling also results in additional cardiac
decompensation from complications, including mitral
regurgitation and cardiac arrhythmias from atrial
remodeling.

47. Diagnosis and Treatment
Diagnosis:
• The measurement of serum natriuretic
peptide and echocardiography have
substantially improved the accuracy of
diagnosis.
• Physical examination,chest radiography
• Pulmonary congestion (with crackles and wheezing)
is predominant.

48. Treatment

49. Plants used in Congestive Heart Failure:

50. DIGITALIS LEAVES
• Common Name: Fox glove and purple foxglove.
Botanical Name:Digitalis purpurea Linn
Part Used: Dried Leaves.
• Family:Scrophulariaceae.
• Geographical distribution: It is mainly found in
England, Germany, France, North
• America, India, Iraq, Japan, Kurdistan, Mexico, Nepal.

51. Chemical Constituents:
Digitalis essentially contains three important primary glycosides namely:
• Purpurea glycoside A, Purpurea glycoside B, and Purpurea glycoside C,
which upon hydrolysis give rise to digitoxin, gitoxin and gitalin/gitaloxin
respectively.
• These secondary glcosides on further hydrolysis yields noncarbohydrate
moieties (called aglycones or genins) digitoxigenin, gitoxigenin and
gitaligenin or gitaloxigenin respectively.
• The crude drug also contains a good number of other glycosides (e.g.;
digitalin, diginin)
• Saponins (e.g.; digitonin, gitin and digitosaponin)
• Tannins, gallic, formic, acetic, succinic and benzoic acids, fatty acids and
• Enzyme digipuridase solely responsible for hydrolysis of purpurea
glycosides.

52. Mechanism of action
• Digitalis works by inhibiting sodium-potassium ATPase. This results
in an increased intracellular concentration of sodium ions and thus
a decreased concentration gradient across the cell membrane. This
increase in intracellular sodium causes the Na/Ca exchanger to
reverse potential, i.e., transition from pumping sodium into the cell
in exchange for pumping calcium out of the cell, to pumping sodium
out of the cell in exchange for pumping calcium into the cell. This
leads to an increase in cytoplasmic calcium concentration, which
improves cardiac contractility.
• As a result of increased contractility, stroke volume is increased.
Ultimately, digitalis increases cardiac output (Cardiac Output=Stroke
Volume x Heart Rate). This is the mechanism that makes this drug a
popular treatment for congestive heart failure, which is
characterized by low cardiac output. Digitalis also has a vagal effect
on the parasympathetic nervous system, and as such is used in re-
entrant cardiac arrhythmias and to slow the ventricular rate
during atrial fibrillation.

53. Medicinal Uses:
• Digitalis enhances the force of contraction of heart muscle which
ultimately affords an increased cardiac output, decreased size of heart,
decreased venous pressure and above all the decreased blood volume.
• Thus digitalis together with its various marketed preparations are
employed profusely as vital cardiotonics in the management and control
of different kinds of congestive heart failure, atrial flutter, atrial fibrillation,
supraventricular tachycardia and premature extra systoles.
Dosage:
Administer one-half the total loading dose initially (all formulations), then
give one-fourth the total loading dose every 6 to 8 hours for two doses (IV
and tablets), or give additional fractions every 4 to 8 hours (oral solution).
-IV: 8 to 12 mcg/kg
-Tablets: 10 to 15 mcg/kg
-Oral solution: 10 to 15 mcg/kg.

54. ATHEROSCLEROSIS
By: Daniyal Khan
14681

55. Intro to Atherosclerosis
• Atherosclerosis (also known as Arteriosclerotic
Vascular Disease or ASVD) the condition in which an
artery wall thickens as the result of a build-up of fatty
materials such as cholesterol affecting arterial blood
vessels, a chronic inflammatory response in the walls
of arteries due to the accumulation of macrophage
white blood cells and promoted by Low-density
lipoproteins without adequate removal of fats and
cholesterol from the macrophages by functional high
density lipoproteins

56. • It is commonly referred to as a hardening or furring of
the arteries.
• It is caused by the formation of multiple plaqueswithin
the arteries.
• It can restrict blood flow. These plaques can also burst,
causing a blood clot.
• Although atherosclerosis is often considered a heart
problem, it can affect arteries anywhere in your body.
• Atherosclerosis is a preventable and treatable condition.

57. Causes
Atherosclerosis starts with damage or injury to the
inner layer of an artery. The damage may be caused
by:
• High blood pressure
• High cholesterol
• An irritant, such as nicotine
• Certain diseases, such as diabetes

58. Pathophysiology
• Atherosclerosis develops as a chronic inflammatory
response of the arterial wall to endothelial injury.
• Lesion progression occurs through interactions of
modified lipoproteins, monocyte-derived macrophages,
T-lymphocytes, and the normal cellular constituent of
the arterial wall.
• The contemporary view of atherosclerosis is expressed
by the response-to-injury hypothesis.

59. Response-to-injury hypothesis
• The following are the
steps involved in the
hypothesis:
1. Chronic endothelial
injury
2. Accumulation of
lipoproteins
3. Monocyte adhesion to
the endothelium
4. SMC proliferations and
ECM production
5. factor release
6. platelet adhesion

60. 1. Chronic endothelial injury
• with resultant endothelial dysfunction, causing
increased permeability, leukocyte adhesion, and
thrombosis
Response-to-injury hypothesis

61. 2. Accumulation of lipoproteins
• (mainly LDL and its oxidized forms) in the vessel wall.
Low-density lipoprotein molecules (LDL) becoming
oxidized (ldl-ox) by free radicals, particularly oxygen
free (ROS). When oxidized LDL comes in contact with
an artery wall, a series of reactions occur to repair the
damage to the artery wall caused by oxidized LDL.
Cholesterol can move in the bloodstream only by being
transported by lipoproteins
Response-to-injury hypothesis

62. 3. Monocyte adhesion to the endothelium
• followed by migration into the intima and
transformation into macrophages and foam cells. The
body's immune system responds to the damage to the
artery wall caused by oxidized LDL by sending
specialized white blood cells (macrophages and T-
lymphocytes) to absorb the oxidized-LDL forming
specialized foam cells. Unfortunately, these white
blood cells are not able to process the oxidized-LDL,
and ultimately grow then rupture, depositing a greater
amount of oxidized cholesterol into the artery wall.
This triggers more white blood cells, continuing the
cycle.
Response-to-injury hypothesis

63. 4. platelet adhesion
5. factor release
• from activated platelet,
macrophages and vascular wall
cells, inducing SMC recruitment,
either from the media or from the
circulating precursors
Response-to-injury hypothesis

64. 6. SMC proliferations and ECM production.
• Eventually, the artery becomes
inflamed. The cholesterol plaque causes
the smooth muscle cells to enlarge and
form a hard cover over the affected
area. This hard cover is what causes a
narrowing of the artery, reduces the
blood flow and increases blood
pressure.
Response-to-injury hypothesis

65. 7. Lipid accumulation
• both extracellularly and within cells
(macrophages and SMC’s). accumulation if
lipid-containing macrophages in the intima
gives rise to “fatty streaks”, with further
evolution, a fibrofatty atheroma consisting of
proliferated SMC, foam cells, extracellular
lipid, and ECM is formed.
Response-to-injury hypothesis

66. Atherosclerosis symptoms depend on which arteries are
affected. For example:
• Atherosclerosis in heart arteries, have symptoms similar to
those of a heart attack, such as chest pain (angina).
• Atherosclerosis in the arteries leading to brain, have
symptoms such as sudden numbness or weakness in your
arms or legs, difficulty speaking or slurred speech, or
drooping muscles in your face.
• Atherosclerosis in the arteries in arms and legs, produces
decreased blood flow is called peripheral artery occlusive
disease (PAOD).have symptoms such as leg pain when
walking
• Sometimes atherosclerosis causes erectile dysfunction in
men.
Symptoms

67. Depending on the results of the physical exam, doctors may
suggest one or more diagnostic tests, including:
• Blood tests.
• Doppler ultrasound
• Ankle-brachial index.
• Other imaging tests.
• Angiogram.
• Electrocardiogram (ECG).
Tests and diagnosis

68. Plants used in Atherosclerosis

69. Allium sativum
• Common Name:Garlic.
Botanical Name:Allium sativum.
• Part Used:Bulbs and Rhizome.
Family: Amaryllidaceae.
Geographical distribution:Garlic is native to Central Asia (Kazakhstan,
Kyrgyzstan, Turkmenistan, Tadzhikistan and Uzbekistan) and northeastern
Iran
• Chemical costituents:
Garlic contains 0.1-0.36% of a volatile oil. These are generally considered to
be responsible for most of the pharmacological properties of garlic. Garlic
contains at least 33 sulfur compounds like aliin, allicin, ajoene, allylpropl,
diallyl, trisulfide, sallylcysteine, vinyldithiines, S-allylmercaptocystein, and
others. Besides sulfure compounds garlic contains 17 amino acids and their
glycosides, arginine and others.
Minerals such as selenium and enzymes like allinase, peroxidases,
myrosinase etc.
the most biologically active compounds, allicin (diallylthiousulfinate or
diallyl disulfide) does not exist in garlic until it is crushed or cut; injury to the
garlic bulb activates the enzyme allinase, which metabolizes alliin to allicin

70. • Mechanism of Action:
• Intact cells of garlic bulbs include an odorless, sulfur-containing amino
acid known as allinin.
• When garlic is crushed, allinin comes into contact with allinase, which
converts allinin to allicin. Allicin has potent antibacterial properties, but it
is also highly odoriferous and unstable.
• Ajoenes, self-condensation products of allicin, appear to be responsible
for garlic's antithrombotic activity.
• Fresh garlic releases allicin in the mouth during the chewing process. Dried
garlic preparations lack allicin but contain allinin and allinase. Since
allinase is inactivated in the stomach, dried garlic preparations should be
coated with enteric so that they pass through the stomach into the small
intestine where allinin can be enzymatically converted to allicin.

71. • Medicinal Uses:
• Lipid-lowering Effects: Garlic's lipid lowering effects may occur via inhibition of
HMG-CoA reductase or other enzymes, possibly by diallyl di- and trisulphide
components of garlic.
• Platelet Effects: Garlic and its derived compound ajoene have demonstrated
inhibition of platelet aggregation In vitro and in animals, and reduction of
platelet-dependent thrombus formation.
• Fibrinolytic Effects: Increased fibrinolytic activity may account for some degree of
garlic's anti-clotting effects, involving fibrinogen and plasminogen.
• Antimicrobial Effects (Bacteria, Fungi, Yeast): Garlic has been demonstrated In
vitro to exert activity against multiple pathogens, including bacteria, including
resistant strains, mycobacteria, Helicobacter pylori and fungi. Garlic extract has
been found to be bactericidal to Histoplasmacapsulatum.Ajoene alone possesses
antibacterial activity against both gram positive and negative bacterial species
and inhibits yeast growth In vitro, and the disulfide bond in ajoene may be
responsible for these effects.
• Lowering of blood glucose and blood pressure; and liver protection.
• Unani physicians also use garlic to treat paralysis, forgetfulness, tremor, colic
pains, internal ulcers and fevers.

72. • DOSAGE:
1. Atherosclerosis:A 300 mg garlic powder tablet taken as a
single dose or three times daily.
• 2. For colon cancer and rectal cancer: Capsules containing 2.4
mL of aged garlic extract taken daily for 12 months have been
used.
• 3. For high blood pressure: 300 mg to 1500 mg of garlic
tablets taken in divided doses daily for 24 weeks.
• 4. For fungal skin infections (ringworm, jock itch, athlete's
foot): garlic ingredient ajoene as a 0.4% cream, 0.6% gel, and
1% gel applied twice daily for one week has been used.

73. Punica granatum
• Common Name:Pomegranate.
Botanical Name: Punicagranatum Linn
• Part Used: Fruit
• Family: Lythraceae
• Geographical region:
Pomegranate is native to a region from Iran to northern India. Pomegranates have
been cultivated throughout the Middle East, South Asia, and Mediterranean
region for several millennia, and also thrive in the drier climates of California and
Arizona
• Chemical constituents:
• Punicalagin
• Punicallin
• Punic acid
• Gallagicacid
• Granatin A
• Casuarinin,
• Pseudopelletierene

74. • Mechanism of action and medicinal uses:
• The potential therapeutic properties of pomegranate are wide-ranging and include treatment and
prevention of cancer, cardiovascular disease, diabetes, dental conditions, erectile dysfunction, and
protection from ultraviolet (UV) radiation.
• Other potential applications include infant brain ischemia, Alzheimer’s disease, male infertility,
arthritis, and obesity.
Plant pacifies tridosha, tapeworm infestation,
• Increase digestive power; alleviate fatigue and thirst and aphrodisiac.
• The juice of fresh leaves and young Pomegranate is given in dysentery.
• The powdered bark is given for expelling roundworms.
• According to Kirtikar and Basu (1935) the unripe fruits and flowers are useful in inducing vomiting,
the rind of the fruit is given in diarrhoea and dysentery.
• They also strengthen the gums.
• Ripe fruit is tonic, laxative and enriches the blood.
• The flower-buds are astringent, and are given in chronic diarrhoea and dysentery.

75. • Dose:
• As an antioxidant 1000 milligrams of pomegranate
extract in the form of POMx™ capsules has been
taken by mouth daily for four weeks.
A dose of 50 milliliters of pomegranate juice has
been taken by mouth daily for three months.
• A dose of 100 grams of fresh pomegranate fruit has
been taken by mouth for 10 days.

76. REFERENCES
• http://jamanetwork.com/journals/jamainternalmedicine/fulla
rticle/210378
• http://www.sigmaaldrich.com/life-science/nutrition-
research/learning-center/plant-profiler/allium-sativum.html
• Bentley and Trimen, Med. Plants 281. 3. Benkeblia, N. 2004.
Antimicrobial activity of essential oil extracts of various onions
Allium cepa& Garlic (Alliceasatium) lebeusmwiss-uTechnol.
373.
• Chemical constituents of cultivated onion Allium
cepaLiliaceae.
• https://restorativemedicine.org/journal/the-use-of-
convallaria-and-crataegus-in-the-treatment-of-cardiac-
dysfunction/.